The New Jersey Department of Health and Senior Services is investigating 40 cases ofE. coli, in four counties and Taco Bell officials are cooperating in the investigation, Commissioner Fred M. Jacobs, M.D., J.D., announced today.

Food histories have been taken in 24 of the cases and 23 of the individuals who became sick ate at a Taco Bell restaurant in either Middlesex, Somerset, Union or Camden counties. They became sick between Nov. 20 and Nov. 29, possibly Nov. 30.

So far, at least 28 cases have been culture confirmed for E. coli, but are pending further test results to determine if they are part of the same strain and are linked to the same outbreak. Some test results may be available as early as tomorrow to determine if the individuals were infected with the H7 strain, which is known to cause more serious illness.

The source of the outbreak has not yet been identified.

In order to help the state with its investigation, three Taco Bell representatives met with Department officials to provide information and assistance about food distribution and processing. Taco Bell has been “very cooperative” and has destroyed all food products and sanitized all equipment and utensils at the South Plainfield franchise that it closed late last week .

Department officials, along with the U.S. Food and Drug Administration, are also investigating the supply chain, which includes the distributor and the distributor’s suppliers. As part of the investigation, Department food safety staff visited the distributor today. Inspections will be done where warranted.

The Department also participated in a multi-state conference call with the federal Centers for Disease Control and Prevention, the FDA along with officials from New York and Pennsylvania, where cases have also been reported.

The Department’s Food Safety and Drug program is working with Taco Bell officials to provide local health departments with uniform guidelines on cleaning procedures that are followed at Taco Bell franchises.

Among the New Jersey cases, there are also two confirmed cases of hemolytic uremic syndrome, which is one of the uncommon but serious complications of infection with E. coli 0157.

Between 50 and 60 sporadic cases of E Coli occur in the state each year.

“We are working closely with the affected county health departments, with neighboring states, with the CDC and the FDA to identify all cases of infection and determine the source of this outbreak,” Commissioner Jacobs said.

Yesterday, New YorkState officials notified the Department of a similar cluster there with similar onset dates.MiddlesexCounty health officials notified the state Department of Health and Senior Services of nine cases on November 29.DHSS officials notified the federal CDC Monday. Somerset and Union counties also notified DHSS on Monday of other suspect cases with an onset of mid-November that are associated with a fast food franchise in Somerset and Union counties.

DHSS has asked regional epidemiologists to re-examine any E. coli cases dating back to November 1 to determine if they may be part of the outbreak.

Escherichia coli 0157:H7are bacteria that normally live in the intestines of healthy people and animals, primarily cattle. Most strains of the bacteria are harmless. E. coli 0157:H7 is a specific strain of E. coli that causes illness.

The symptoms of E. coli 0157:H7 infection can vary. Some individuals have no symptoms. Others may have mild to severe diarrhea, which may contain blood. Abdominal cramps, nausea and vomiting may occur. Usually there is little or no fever present. A small number of patients develop complications, such as hemolytic uremic syndrome.

Symptoms of illness usually appear about three days after swallowing the bacteria, but can range from one to eight days.

Most individuals who become ill with E. coli 0157:H7 infection recover on their own within a week. Some however, may require hospitalization to administer intravenous fluids to prevent dehydration. Antibiotics may be prescribed by a physician to treat severe cases of illness.